While fans focus when a receiver is trying to catch a pass, few notice the people on the sidelines -- the athletic trainers, doctors and physical therapists -- who stand ready to treat any athlete's injury.
Bernie Stento, a teacher and licensed athletic trainer at Chesterton High School, recalls when a football player was injured this fall. He had to render aid and decide how to treat the injury.
"A freshman student-athlete caught a pass but was hit on the side of the head, and he went down," Stento said.
"He was conscious but out of it. We went out and took our time to evaluate him, making sure he didn't have any neck issues. I saw the injury right before my eyes. He was only 10 to 15 yards away from me. My first thought was: concussion."
Medical personnel are at football and most girls and boys sports games to treat injured students. Indiana does not require schools to have an athletic trainer but if a school has one, that person must be licensed.
Indiana law allows a person with a physical therapy license to work as an athletic trainer, the Indiana Attorney General's office said.
Illinois recommends athletic trainers be used to treat student injuries, but it's not required by law, said Brittany Mitacek, a licensed athletic trainer for T.F. South High School in Lansing.
According to the National Athletic Trainer Association website, certified athletic trainers help prevent and treat injuries. Their clients can be professional athletes or industrial workers, and they work with them to manage and rehabilitate acute injuries.
Physical therapists diagnose and treat individuals with limited ability to move and perform functional activities due to medical problems or conditions. Physical therapists help patients develop, restore and maintain movement and physical function.
Athletic trainers must have a bachelor's degree from an accredited program and pass a certification test. Physical therapists also must have a bachelor's degree and an advanced degree from an accredited physical therapy program.
The Indiana Athletic Trainers Board oversees licensed athletic trainers in the state, according to Director Crystal Heard. She said there are no pending complaints against anyone in Northwest Indiana.
Complaints are filed at the Indiana Attorney General's Office, said Indiana Athletic Trainers Board spokeswoman Sue Swayze.
Mitacek said T.F. South has athletic trainers, one of whom is a teacher, who initially evaluate injuries, provide emergency medical care and advise on nutrition, strengthening and conditioning.
"We see most injuries during the football season," Mitacek said. "In girls sports, we see more injuries in cheerleading and basketball."
They refer students to doctors when necessary, she said.
East Porter County Superintendent Rod Gardin said his district doesn't have an athletic trainer or a doctor. The district doesn't have football, and has a nurse on duty for its sports; if it's an emergency, they'd call 911, Gardin said.
"I'm in my ninth year here and there hasn't been any kind of event that would have required an athletic trainer," he said.
Athletic trainers provide instant care
Stento said when he saw the freshman student go down, there were two things in his favor: it was near the end of the game and the student's parents were there.
"I waved to them and they came down," Stento said. "We went back to the stadium facility and I was able to take a look at him."
Over the next few days, the student saw a doctor and Stento continued to follow him at school. The student is fine now, Stento said.
Highland High School senior Derek Carr, 18, said he had a similar experience. As an offensive lineman junior year, he broke a fibula and dislocated his ankle.
"I just kind of fell on my leg and there was a pile on me and it broke," he said. "I was lying out on the field and (athletic trainer) Patrick Ohaver came running out to the field."
That was October 2012. Carr had surgery and his left leg was in a cast up to his waist for two months, then up to his knee for another two months. Eventually, he had surgery again to remove a screw and was able to begin stretching and rehabilitating his leg and ankle. He said he had a slight sprain this year but worked with Ohaver to relieve the symptoms.
"I was in his office every day doing something so I could play again," Carr said. "I was able to play two weeks after I sprained my ankle. I wouldn't have been able to do that without an athletic trainer. It's a tough profession. I have a lot of respect for them."
John Doherty, athletic trainer at Munster High School and director of the Concussion Clinic at Community Hospital in Munster, said athletic trainers at schools provide day-to-day health care services for athletes.
Doherty is a licensed physical therapist and licensed athletic trainer and has been at Munster for 29 years.
"I'm at the school every day. We do rehab on athletes who are recovering and coming off injuries. We coordinate care with doctors and families," he said.
Doherty also provides services to schools in Hammond, Whiting, Highland, Griffith, the Lake Central School Corp., Calumet High School and Purdue University Calumet.
Many times, athletic trainers also provide services to middle school athletes, Doherty said.
Portage Superintendent Ric Frataccia said students get hurt in practice and at games.
"They need someone with knowledge to give them a diagnosis of the injury and treatment, as well as teach them some things they can do to help themselves," he said.
Frataccia said athletic director Kelly Bermes oversees the athletic department. Athletic trainers are supplied to the school by the Lakeshore Bone & Joint Institute.
Some high schools also have volunteer team doctors.
Dr. Jennifer Bayer, an orthopedic surgeon with Great Lakes Orthopedics & Sports Medicine in Crown Point and St. John, is one of the doctors who provides services to Lake Central Schools, Crown Point Community School Corp., Tri-Creek Community Schools and Merrillville schools.
As the team doctor for Lowell High School, Bayer attends all football games during the season. She is at the school weekly during football season to work with injured students in the training room and she is there every other week after the season.
"As a physician, we can gauge the type of injury we see on the field," she said. "I work in conjunction with the athletic trainers to treat the student."
Bayer, who was a student-athlete, graduated from Lowell High School in 1999. She said there is a coordination of care among athletes, athletic trainers and physicians. She said students are honest about what bothers them and want to get better.
Concussions are the critical issue
Doherty said concussions occur more often in football, but also in soccer, hockey and wrestling. In women's sports, the highest number of concussions are found in women's collegiate hockey. At high school, it occurs more frequently in boys football, girls soccer and wrestling, he said.
"Everybody heals after the first concussion," he said, but it's harder to heal after a second or third concussion.
"Football is a violent sport. ... No position is immune to the violence of the game," Doherty said.
He noted some games are safer alternatives, but risks are always involved.
Doherty also said football might look different in 10 years, because contact may become limited.
James Dye, who holds a doctorate in physical therapy, has a contract with the Gary Community School Corp. and serves as the school's medical director. He also takes care of athletes at Thea Bowman Leadership Academy. He and a team of four physical therapy assistants and technicians attend all high school sports games and offer a clinic in Gary.
Dye said they treat between 500 and 600 injuries per school year, and see students in his Gary clinic to work on conditioning, strengthening and other issues.
"Many of the inner-city kids don't have insurance and don't see doctors regularly," he said. "We see them for free. They can come here and be served, and their parents don't receive a bill."